Provider Demographics
NPI:1689939597
Name:THOMAS, CHARLES FORREST (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FORREST
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LUMMI DR
Mailing Address - Street 2:
Mailing Address - City:LA CONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257-9631
Mailing Address - Country:US
Mailing Address - Phone:360-466-5895
Mailing Address - Fax:360-466-5895
Practice Address - Street 1:110 LUMMI DR
Practice Address - Street 2:
Practice Address - City:LA CONNER
Practice Address - State:WA
Practice Address - Zip Code:98257-9631
Practice Address - Country:US
Practice Address - Phone:360-466-5895
Practice Address - Fax:360-466-5895
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD18749207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD18749OtherSTATE LICENSE
WAMD18749OtherSTATE LICENSE